Proof That Your Client is Progressing

When dealing with a client (or patient) who has been experiencing chronic pain, particularly lower back pain, they often become discouraged at the somewhat slow progress when working towards their goals.  The first thing you want to do is the obvious...make sure they are doing what they are supposed to be doing when they are not working with you (They should be compliant with a home exercise program on a daily basis).  So that you can make educated observations on your client's progress, you should begin with a detailed initial assessment with Objective and Subjective information.  Each session, you should be writing notes not only on what exercises your client is performing, but range of motion and strength measurements, observations on quality of movement, and quantity of work performed before rest is required (Endurance or Activity Tolerance).  This is the information that you will need to show the client many times to carry them along, minimizing discouragement and depression.  So many times, I am working with a client recovering from lower back pain and I hear "my pain has not changed at all since we started."  I explain that this is common.  As they make progress in their rehab sessions, they are able to perform more work outside of the clinic.  More work outside of the clinic is just like performing more exercise or new exercise in the gym.  This causes an increase in soreness.  When I look through the chronological notes with the client/patient, my explanation usually sounds like this..."When we first started, you felt 5/10 (pain score 5 on a scale from 0-10) when getting out of bed in the morning and were unable to perform any additional activities throughout the day without the pain increasing to a 7 out of 10 on the pain scale.  Now, you are exercising daily, cleaning your house, you have returned to work and your pain level is 5 out of 10.  That's progress!!!"  Progress is not a 'black or white' situation.  It is usually slow and steady.  Explain this to your clients and open their eyes to what other details they need to be focused on in order to truly assess their own progress.  Take their minds off "pain, pain, pain," and show them the other aspects which they have made improvements in.  Your clients are looking to you for support and guidance.  They are trusting you with their health and wellness.  Give them as much information on their progress as you can.  Don't just spit out a bunch of weight and rep numbers to show them that they have improved. That information does not mean much in terms of overall functional abilities.  Keep detailed records.  Many times, clients are selective in what they remember, especially when they are  not progressing as quickly as they would like to.  Show them they are not wasting their time.

Osteoporosis: Gym Machines to Avoid

Many women are diagnosed with osteoporosis, which is basically loss of bone density.  With "weak bones," there are a few movements and machines that you should avoid using in the gym, because they place excessive strain on certain bones of the body.  First, the seated hip abductor machine may apply too much stress on the hips/femurs.  This may actually create femur or hip fractures, resulting in a total hip replacement.  The crunch machine as well as the seated trunk extension machine may cause spinal fractures due to vertebral shearing anterior/posterior upon muscle contraction.  Lastly, the seated row machine, especially without chest support may cause compression/spinal fractures.  So if you are working with a client with the diagnosis of Osteoporosis, beware of these machines.  Use your imagination and find other ways to work these hip and trunk muscles.

P.R.F.C.T. ("PERFECT") TECHNIQUES: UPPER EXTREMITY BIAS

KB FITNESS or Knowledge Based Fitness presents P.R.F.C.T. (PERFECT) Techniques, which stands for Post Rehab Fitness Circuit Training Techniques.  These explanatory videos offer information for trainers and their clients on the how-to and functional benefits of many exercises, in order to guide their progression and prevent and/or recover from injuries.

The following video is the Nabard Long Device Lateral Thrust. 
http://youtu.be/_5tghrO5bQA


There are many benefits of this exercise, as it is a full body technique.  However, it is especially good for the upper extremity, including strengthening the shoulder, forearm, wrist and hand (grip).  This exercise provides:

1) Scapula Stabilization:  You must maintain isometrically retracted scapula when performing this, or else you risk causing shoulder injuries.  Scapular retraction is a major posture component.  So this technique will benefit posture and those clients recovering from shoulder injuries. 

2) Grip strength: With the offset handle of the device, you are forced to grip it tightly in order to control it.  Read the prior blog post on grip strength, irradiation and the homunculus for more details.  This movement also works on hand coordination and speed, as you transition from gripping the device to releasing the device frequently.

3)Core/Trunk rotation: As you increase speed of trunk rotation, you demand more from your core to control the rotation.  You should not allow the device to create rotation of your trunk.  Your trunk is what propels the device.  Maintaining core recruitment throughout the entire motion will protect your spine.

4) Dynamic stretch of the psoas: The psoas muscle is a hip flexor and is commonly tight in people with lower back issues.  When performing this exercise, the leg you are pushing off (the trailing leg) finishes in full hip extension with a gluteal contraction.  This maintains flexibility of the psoas.  If someone has a tight, symptomatic psoas/lower back, they may stop short of full hip extension and even hyperextend their lower back in order to complete the movement.  Watch for these compensations and correct them.  The hip drive you perform with this "trailing" leg during trunk rotation is a common motion in many sports.  As you become accustomed to the movement, increase the amount of hip drive.  This is a great technique to include in a athletes training program.

5) Foot speed: You must be able to adjust your weight distribution from 1 leg to the other frequently, rapidly, and safely to perform this technique.  As the demand on the upper body changes, the weight distribution on the lower extremities must also adjust in order to maintain balance and efficiency. 

So, give it a try.  Keep the upper points in mind throughout, and always move with P.E.R.F.E.C.T. Technique. 

Please help me provide you with valuable information:
1.  For those reading this blog, what type of information would be of interest to you in a rehab/fitness blog or website? 
2. What would you like to learn as a fitness/rehab professional or as someone recovering from an injury?
Questions, comments or requests, please contact me at: nicparm7777@aol.com

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Dyna-Core Training: Core Stabilization Progressions

     We have all heard that "A house is only as strong as its foundation."  Well, similarly, our bodies are only as strong as our core stability/strength.  Without core stability, we would not even be able to walk.  In Physical Therapy and Personal Training, we teach our clients how to engage their core during various activities.  Static Stabilization is trained with minimal to no body movement (Static Plank).  Exercises which incorporate extremity movement while continuing to maintain a neutral spine are an example of Dynamic Stabilization (Dynamic Plank).  Unfortunately in every day life, we are required to not only maintain an engaged core while moving our extremities, but are also performing tasks that require the spine to transition in and out of the neutral position.  If we do not learn how to maintain an engaged core throughout our spine's available range of motion (Controlled Mobility/Stability), injury is inevitable. 
     Dyna-Core Training focuses on "Controlled Mobility Training."  You are not just going through the 'exercise motions' in hopes to break a sweat and burn calories.  You are becoming more efficient in functional movement patterns.  This is "Purposeful Training." 
     Going through Physical Therapy School, we were taught that a good therapist has "many tools in his/her toolbox."  A certain technique may work great on one client but not at all on another client.  So we must learn as many techniques, treatments, exercises, modalities, etc as possible in order to maximize results, improve retention and reduce boredom.  One tool that I have found to assist in enhancing this "Controlled Mobility Training" takes advantage of the Nabard Fitness System Devices.  Please watch the video for more details.
http://www.youtube.com/watch?v=-DD96ukM1bo

Does Your Client Have Shoulder Issues?

If your client complains of shoulder discomfort, tightness or displays a limited range of motion with such exercises as the Shoulder Press or Kettlebell Snatch, it may be beneficial to teach him/her to perform a gentle Lateral Distraction Joint Mobilization for the Gleno-humeral Joint (shoulder).

In this video clip, learn a quick an easy "self" joint mobilization technique that will provide the following benefits:
-Improve overal shoulder range of motion/flexibility by gently stretching the joint capsule
-Assists in Synovial Fluid lubricating the shoulder joint
-Pain relief

Following the technique, be sure reassess the shoulder range of motion.  Then attempt the exercise again to see if you have made progress.

*Helpful with Frozen Shoulder (adhesive capsulitis) and impingement syndrome

http://www.youtube.com/watch?v=8pNziq4Ckbg

Multi-Angle Deadlift

Simple exercise to set up, all you need is 4 cones and possibly a kettlebell (challenging with no weight also). 
Click below for the video
 
Tips to remember:
-HIP HINGE!!! Do not bend through the lower back segments
-Maintain body weight on the posterior aspect of your foot (heel)
-Keep your hip bones facing forward (minimal rotation)

Functional Values:
-Glute Recruitment for lower back stability
-Core engagement
-Single leg balance
-Ankle and knee stability
-Acceleration/Deceleration pattern for sports
-Kinesthesia for the lower body

http://www.youtube.com/watch?v=-ZO1ZUjyntU

Enjoy,

Nick

LOG TRAINING: New to the Fitness Industry

Recently, I had the privilege to learn the new training technique created by Master Safakhoo of Nabard Fitness Systems.  This training tool, called Log Training, has many advantages and benefits.  It can be used  not only by fitness enthusiasts, but also for athletes, especially martial artists, MMA, tennis and golf players. As a Physical Therapist and Personal Trainer, I see this new fitness tool to be one of the most diverse in the industry.  Check out the link below and http://www.strengthondemand.com/ for more info.

  http://www.youtube.com/watch?v=tCo30lBPIHU

Morning Stretches

Many of my patients and clients have previously been diagnosed with lower back bulging or herniated discs.  They have become frustrated because they can not function the way they used to due to the back and sometimes radiating leg pain.  When I ask them what their normal daily routine is, they tell me they wake up in the morning and begin a short stretch routine that usually consists of getting out of bed and bending forward to touch their toes.  They say this makes them feel less lower back stiffness.  Unfortunately, I explain to them that bulging or herniated discs may actually worsen with this morning routine.  Most often, a bulging disc is triggered by a flexion or bending maneuver.  If it is a forceful flexion movement, the intervertebral disc may actually bulge posteriorly and laterally.  This may "pinch" a nerve root in your spine.  That is why you feel symptoms in your leg.  During the night, gravity is no longer compressing your spine so the discs reabsorb their fluid.  If you already have a problem with that disc level, flexion of the spine with a disc that has become "swollen" with its own fluid can cause the disc to protrude, exacerbating your back problem.  My advice is to minimize your lower back flexion activities and begin a core strengthening program.  Although flexion type stretches may feel good, it is only temporary and may actually be slowing your progress.